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Resumen Objetivos La insuficiencia cardiaca (IC) y la diabetes son 2 procesos fuertemente asociados. El objetivo principal fue analizar la evolucion del pronostico de los pacientes con diabetes que ingresan por IC a lo largo de 2 periodos. Metodos Estudio prospectivo para comparar el pronostico a un ano de seguimiento entre los pacientes con diabetes que ingresan por IC en 2008-2011 y 2018. Los pacientes proceden del Registro Nacional de Insuficiencia Cardiaca (RICA) de la Sociedad Espanola de Medicina Interna. El objetivo primario fue analizar el desenlace combinado de mortalidad total o ingreso por IC durante 12 meses. Se utilizo una regresion multivariante de Cox para evaluar la fuerza de asociacion (hazard ratio [HR]) de la diabetes y los desenlaces entre ambos periodos. Resultados Se incluyo a un total de 936 pacientes en la cohorte de 2018, de los que 446 (48%) tenian diabetes. Las caracteristicas basales de la poblacion de los 2 periodos fueron similares. En los pacientes con diabetes se observo el desenlace combinado en 233 (47,5%) en la cohorte de 2008-2011 y 162 (36%) en la cohorte de 2018 (hazard ratio [HR] 1,48; intervalo de confianza del 95% [IC95%] 1,18-1,85; p Conclusiones En 2018 se observa una mejoria del pronostico de la mortalidad total y los reingresos durante un ano de seguimiento en pacientes con diabetes hospitalizados por IC con respecto al periodo de 2008-2011.

Hyperglycemia in hospitalized patients, either with or without diabetes, is a common, serious, and costly healthcare problem. Evidence accumulated over 20 years has associated hyperglycemia with a significant increase in morbidity and mortality, both in surgical and medical patients. Based on this documented link between hyperglycemia and poor outcomes, clinical guidelines from professional organizations recommend the treatment of hospital hyperglycemia with a therapeutic goal of maintaining blood glucose (BG) levels less than 180 mg/dL. Insulin therapy remains a mainstay of glycemic management in the inpatient setting. The use of non-insulin antidiabetic drugs in the hospital setting is limited because little data are available regarding their safety and efficacy. However, information about the use of incretin-based therapy in inpatients has increased in the past 15 years. This review aims to summarize the different treatment strategies for hyperglycemia in hospitalized noncritical patients that are supported by observational studies or clinical trials with insulin and non-insulin drugs. In addition, we propose a protocol to help with the management of this important clinical problem.

Resumen Objetivo Evaluar el uso de la terapia con beneficio cardiovascular en pacientes con DM tipo 2 previo al ingreso en servicios de medicina interna. Metodos Estudio transversal en un dia de los pacientes con DM tipo 2 hospitalizados en servicios de medicina interna. Se recogieron variables demograficas y antropometricas, datos de laboratorio y utilizacion de farmacos antihiperglucemiantes. La variable desenlace fue la proporcion y los determinantes de uso de inhibidores del cotransportador sodio-glucosa 2 (iSGLT2) y de agonistas del receptor del peptido similar al glucagon tipo 1 (AR-GLP1). Resultados Se incluyeron 928 pacientes pertenecientes a 74 hospitales. La edad media fue 78,9 anos (DE: 10,86), un 50% varones. Un total de 557 (60%) presentaba cardiopatia isquemica, 189 (20,4%) enfermedad cerebrovascular, 293 (31,6%) insuficiencia cardiaca, 274 (29,5%) enfermedad renal cronica y 129 (13,9%) enfermedad arterial periferica. Los antihiperglucemiantes utilizados previo al ingreso fueron: sulfonilureas (5.7%), biguanidas (49.1%), inhibidores de la alfa-glucosidasa (0,2%), pioglitazona (0%), iDPP4 (39%), iSGLT2 (5,8%), AR-GLP1 (2,6%) y analogos de insulina basal (24%). La edad mayor de 75 anos fue el factor determinante principal para no utilizar iSGLT2 (OR ajustada 0,28; intervalo de confianza al 95%: 0,10-0,74; p = 0,039) o AR-GLP1 (OR ajustada 0,09; intervalo de confianza al 95%: 0,02-0,46; p = 0,006). Discusion Una gran proporcion de pacientes ancianos con DM tipo 2 de muy alto riesgo cardiovascular no recibe terapia antihiperglucemiante con farmacos de probado beneficio cardiovascular. El tratamiento mas frecuentemente utilizado fue metformina e iDPP4. Existe un margen de mejora en el tratamiento en esta poblacion de muy alto riesgo.

Resumen Introduccion La obesidad es una enfermedad metabolica cronica, compleja y multifactorial, implicada en el desarrollo de enfermedades cronicas no transmisibles como la diabetes mellitus tipo 2, las enfermedades cardiovasculares y el cancer. Es necesario que la atencion a las personas con obesidad sea una parte esencial de la vision integral que la medicina interna aporta a la persona enferma. Material y metodos Entre septiembre de 2019 y enero de 2020 se difundio una encuesta en linea a los socios de la Sociedad Espanola de Medicina Interna; se elaboro un analisis DAFO con las respuestas y, mediante la tecnica de Grupo Nominal, se elaboraron las recomendaciones. Resultados Obtuvimos 599 respuestas. Edad media 44,4 ± 11 anos; 52,1% mujeres. El 91,8% de los internistas evalua a los pacientes para descartar las comorbilidades asociadas a la obesidad, principalmente la diabetes mellitus tipo 2 (96,2%), la enfermedad cardiovascular (88,9%) o el sindrome de hipoventilacion asociada a obesidad (73%), entre otros. El 79,9% proporciona indicaciones sobre modificacion del estilo de vida. El 64,1% y el 74,9% conocen las indicaciones de los farmacos y de la cirugia bariatrica, respectivamente. El 93,8% y el 83% consideran la obesidad y el sobrepeso una enfermedad cronica y el 88,7% una patologia propia del internista, debiendo tener un papel activo y protagonista en su tratamiento (85,3%). Conclusiones El objetivo del presente documento es dar a conocer el grado de conocimiento y de sensibilidad de los internistas frente al manejo de la obesidad y elaborar un consenso de recomendaciones de la Sociedad Espanola de Medicina Interna basadas en la evidencia cientifica y en la opinion de sus miembros.

Resumen Los cambios adecuados del estilo de vida reducen significativamente los factores de riesgo cardiovascular asociados a la prediabetes y la diabetes mellitus tipo 2, por lo que en su manejo se debe recomendar un patron saludable de alimentacion, actividad fisica regular, no consumir tabaco, y una buena higiene del sueno. Hay una solida evidencia de que los patrones alimentarios de base vegetal, bajos en acidos grasos saturados, colesterol y sodio, con un alto contenido en fibra, potasio y acidos grasos insaturados, son beneficiosos y reducen la expresion de los factores de riesgo cardiovascular en estos sujetos. En este contexto destacan la dieta mediterranea, la dieta DASH, la dieta baja en hidratos de carbono y la dieta vegano-vegetariana. Adicionalmente, en la relacion entre nutricion y estas enfermedades metabolicas es fundamental dirigir los esfuerzos a prevenir la ganancia de peso o a reducir su exceso en caso de sobrepeso u obesidad, y personalizar el tratamiento para favorecer el empoderamiento del paciente. Este documento es un resumen ejecutivo de una revision actualizada que incluye las principales recomendaciones para mejorar la calidad nutricional de la alimentacion en las personas con prediabetes o diabetes mellitus tipo 2, disponible en las paginas web de la Sociedad Espanola de Arteriosclerosis, la Sociedad Espanola de Diabetes y la Sociedad Espanola de Medicina Interna.

Resumen La diabetes tipo 2 constituye un problema de salud de elevada prevalencia y morbimortalidad. El tratamiento medico tiene una complejidad creciente en relacion con las diversas situaciones clinicas del paciente. Este articulo recoge un documento de consenso de las recomendaciones para el tratamiento medico de la diabetes tipo 2 del Grupo de Diabetes, Obesidad y Nutricion de la Sociedad Espanola de Medicina Interna. El objetivo principal de este articulo es facilitar la toma de decisiones terapeuticas para mejorar la atencion de los pacientes con diabetes. El documento prioriza los tratamientos con beneficios cardiovasculares, especialmente la insuficiencia cardiaca, y renales.

Resumen La Sociedad Espanola de Medicina Interna ha desarrollado a lo largo de 2018-2019 el proyecto «El hospital del futuro». El hospital del futuro pretende trasladar al contexto del sistema sanitario espanol la reflexion que abordo el Royal College of Physicians en el Reino Unido sobre la organizacion de la asistencia en los hospitales del futuro, desde el conocimiento acumulado sobre el Sistema Nacional de Salud. En el proyecto participaron asimismo numerosas sociedades cientifico-medicas y entidades profesionales del sector salud y asociaciones de pacientes. Este articulo tiene por objeto destacar en 10 puntos las previsiones que consideramos mas relevantes derivadas de este proyecto, dedicando el ultimo a los retos que para la Medicina Interna se deducen de estas propuestas.

Aim The heterogeneity of patients with heart failure and preserved ejection fraction (HFpEF) is high, thus this entity tends to be grouped into phenotypes to act with precision. Within these groups, patients with type 2 diabetes mellitus (DM2) hold this heterogeneity. Our aim is to describe subgroups of patients with HFpEF and DM2 based on other comorbidities. Material and methods Patients were recruited from the national registry of heart failure (RCIA). Patients with ejection fraction greater than or equal to 50% without valvular disease and with DM2 were included. A hierarchical agglomerative analysis was performed with Ward's method including the following variables: dyslipidemia, liver disease, Chronic obstructive pulmonary disease (COPD), dementia, cerebrovascular disease, arrhythmia, systolic blood pressure, body mass index (BMI), estimation of glomerular filtration and hemoglobin. Results A total of 1934 patients with HFpEF were included, of which 907 (46.9%) had DM2 with a predominance of women (60.9%) and with a BMI of 31.1 (5.9) Kg/m2. Four groups were obtained, two with high vascular risk (one with arrhythmia and the other without it) with 263 patients the first and 201 the second. A third group had a predominance of COPD (140 patients) and a last group with 303 patients older but with less comorbidity. Conclusions In our patients with HFpEF and DM2, obesity and female sex predominated. All four groups offered treatment chances to improve their prognosis not only based on the use of new antidiabetic drugs but also on other options that may be a starting point for further research

Resumen Antecedentes y objetivos La heterogeneidad de los pacientes con insuficiencia cardiaca y fraccion de eyeccion preservada (ICFEP) es elevada, por lo que se tiende a agrupar en fenotipos para intervenir con precision. Dentro de estos, los pacientes con diabetes mellitus (DM) mantienen esta heterogeneidad. Nuestro objetivo es describir grupos de pacientes con ICFEP y DM basados en otras comorbilidades. Material y metodos Los pacientes se reclutan desde el registro nacional de insuficiencia cardiaca (RICA). Se incluyen pacientes con fraccion de eyeccion mayor o igual al 50% sin valvulopatia y con DM. Se realiza un analisis aglomerativo jerarquico con el metodo de Ward incluyendo las siguientes variables: dislipemia, hepatopatia, EPOC, demencia, enfermedad cerebrovascular, arritmia, presion arterial sistolica, indice de masa corporal (IMC), estimacion del filtrado glomerular y hemoglobina. Resultados Se incluyen 1.934 pacientes con ICFEP, de los que 907 (46,9%) tenian DM, con predominio de mujeres (60,9%) y con un IMC de 31,1 (5,9) kg/m2. Se obtienen 4 grupos: dos con elevado riesgo vascular (uno con arritmia y otro no), con 263 pacientes el primero y 201 el segundo, otro con predominio de EPOC (140 pacientes) y un ultimo grupo de 303 pacientes con mas edad pero menos comorbilidad. Conclusiones En nuestros pacientes con ICFEP y DM predomina la obesidad y el sexo femenino. Los cuatro grupos ofrecen oportunidades de tratamiento para mejorar su pronostico no solo basadas en la utilizacion de nuevos farmacos antidiabeticos sino por otras opciones que pueden suponer un punto de partida para nuevas investigaciones.

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals.

Objectives To compare the structure, resources and activity of the internal medicine units (IMUs) of the Spanish National Health System (SNHS) in 2013 and 2016. To analyze the differences between IMUs in 2016 by hospital size. Material and methods We conducted a comparison of 2 descriptive cross-sectional studies of IMUs in general acute care hospitals of the Spanish National Health System, with data referring to 2013 and 2016. The variables were collected via an ad hoc questionnaire (RECALMIN survey). Results Between 2013 and 2016, the demand for care increased dramatically (with an annual average of 11% in hospital discharges and 16% in first consultations), and comorbidity slightly increased (2%). During this period, the mean productivity of IMUs increased 16.7% (0.6 ± 0.3 vs. 0.7 ± 0.3; p = .09), and the mean stay decreased 10% (9 ± 2.2 vs. 8.1 ± 2.1 days; p = .001). Progress in implementing good practices and systematic care for complex chronic patients was scarce. Both surveys found variability among IMUs and marked differences among IMUs of hospitals of different sizes. Conclusions IMUs responded to the increased burden of care they supported during 2013–2016 by improving their efficiency and productivity; however, advances in implementing good practices, including care for chronic complex patients, were scare. The significant variability in the indicators of structure, activity and management models found in 2013 remained in 2016.

Heart failure (HF) and diabetes are 2 strongly associated diseases. The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2 time periods.This work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008-2011 or 2018. The patients are from the Spanish Society of Internal Medicine's National Heart Failure Registry (RICA, for its initials in Spanish). The primary endpoint was to analyze the composite outcome of total mortality and/or readmission due to HF in 12 months. A multivariate Cox regression model was used to evaluate the strength of association (hazard ratio [HR]) between diabetes and the outcomes between both periods.A total of 936 patients were included in the 2018 cohort, of which 446 (48%) had diabetes. The baseline characteristics of the populations from the 2 periods were similar. In patients with diabetes, the composite outcome was observed in 233 (47.5%) in the 2008-2011 cohort and 162 (36%) in the 2018 cohort [HR 1.48; 95% confidence interval (95%CI) 1.18-1.85; p .001]. The proportion of readmissions (HR 1.39; 95%CI 1.07-1.80; p = .015) and total mortality (HR 1.60; 95%CI 1.20-2.14; p .001) were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort.In 2018, an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008-2011 period.

Adequate lifestyle changes significantly reduce the cardiovascular risk factors associated with prediabetes and type 2 diabetes mellitus. Therefore, healthy eating habits, regular physical activity, abstaining from using tobacco, and good sleep hygiene are recommended for managing these conditions. There is solid evidence that diets that are plant-based; low in saturated fatty acids, cholesterol, and sodium; and high in fiber, potassium, and unsaturated fatty acids are beneficial and reduce the expression of cardiovascular risk factors in these subjects. In view of the foregoing, the Mediterranean diet, the DASH diet, a low-carbohydrate diet, and a vegan-vegetarian diet are of note. Additionally, the relationship between nutrition and these metabolic pathologies is fundamental in targeting efforts to prevent weight gain, reducing excess weight in the case of individuals with overweight or obesity; and personalizing treatment to promote patient empowerment. This document is the executive summary of an updated review that includes the main recommendations for improving dietary nutritional quality in people with prediabetes or type 2 diabetes mellitus. The full review is available on the webpages of the Spanish Society of Arteriosclerosis (SEA, for its initials in Spanish), the Spanish Diabetes Society (SED, for its initials in Spanish), and the Spanish Society of Internal Medicine (SEMI, for its initials in Spanish).

The emergence of the COVID-19 pandemic represents an enormous challenge. Given the considerable presence of type 2 diabetes mellitus in the current population, the pandemic is a health issue that requires an effort to provide better responses to our patients who are more vulnerable to the onset of infection and who are candidates for presenting more severe symptoms. This document attempts to address the relationship between COVID-19 infection and type 2 diabetes mellitus. To this end, we will briefly analyse whether the epidemiological data support this association and, subsequently, go in depth on the pathophysiological mechanisms that might connect the two diseases.

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals.

Type 2 diabetes mellitus is a major health problem with high prevalence, morbidity and mortality, and its medical treatment is growing in complexity due to patients' diverse clinical conditions. This article presents a consensus document by the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine, with recommendations for the medical treatment of type 2 diabetes mellitus. The main objective of this article is to facilitate the therapeutic decision-making process to improve the care of patients with diabetes. The document prioritises treatments with cardiovascular benefits, especially those that benefit patients with heart and renal failure. (C) 2020 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.

Resumen La diabetes mellitus tipo 2 es la principal causa de enfermedad renal cronica. Estos pacientes presentan mayor morbimortalidad y riesgo de hipoglucemias que el resto. En 2010, la diabetes tipo 2 fue causa del inicio de terapia renal sustitutiva en el 24,7% de los pacientes. La prevalencia de microalbuminuria, proteinuria y disminucion del filtrado glomerular es del 36, 8, y 22%, respectivamente. La presencia de albuminuria es un factor predictivo de enfermedad renal cronica. La enfermedad renal diabetica, previamente conocida como nefropatia diabetica, hace referencia a la enfermedad renal causada por la diabetes. La hiperfiltracion renal es marcador de hipertension intraglomerular y factor de riesgo tanto de inicio como de progresion. Los nuevos antidiabeticos, fundamentalmente los inhibidores del enzima dipeptidil peptidasa-4, los inhibidores del cotransportador de sodio/glucosa y los agonistas del peptido similar al glucagon tipo 1, han demostrado prevenir o enlentecer la progresion de la enfermedad renal.

Resumen Objetivos Tanto las complicaciones hospitalarias como la hiperglucemia son frecuentes en pacientes ancianos durante su hospitalizacion. Nuestro objetivo fue analizar la relacion que existe entre la hiperglucemia y las complicaciones hospitalarias en una poblacion envejecida. Metodos Llevamos a cabo un estudio observacional para evaluar la relacion existente entre las concentraciones de glucosa maxima en sangre (GMS) y las complicaciones hospitalarias. Los pacientes fueron estratificados segun los cuartiles de las concentraciones de GMS. La diabetes mellitus (DM) se determino a traves de la historia del paciente y/o los niveles de hemoglobina glucosilada (HbA1c) ≥ 6,5% en el momento del ingreso hospitalario. La hiperglucemia en pacientes sin DM se definio como hiperglucemia inducida por estres (HE). El punto final primario compuesto incluyo las complicaciones frecuentes y/o la mortalidad hospitalaria por todas las causas. Resultados De un total de 461 pacientes, media de edad 80 ± 7,5 anos, 238 (51,6%) presentaban DM, 20 tenian DM no diagnosticada y 162 (35,1%) desarrollaron complicaciones hospitalarias. Los pacientes con complicaciones presentaban concentraciones diarias medias mas altas de glucosa en sangre (215 ± 84 vs. 195 ± 85 mg/dl, p 250 mg/dl, 60%; p = 0,002), no asi en pacientes con DM ( 250 mg/dl, 37,4%; p = 0,748). Segun los analisis multivariados que se llevaron a cabo, la HE se asocio, independientemente, a las complicaciones: OR: 2,60 (IC 95%: 1,2-5,6), 2,82 (IC 95%: 1,2-6,5), 5,50 (IC 95%: 1,4-20,8) para el segundo, tercer y cuarto cuartiles, respectivamente (p = 0,01) comparado con el primer cuartil. No encontramos relacion alguna entre las rehospitalizaciones y la mortalidad por todas las causas. Conclusiones La HE en pacientes ancianos se asocio a las complicaciones hospitalarias, pero no a la mortalidad por todas las causas, comparado con pacientes con diabetes o con pacientes normoglucemicos.

Objectives To estimate the prevalence of obesity in patients treated by departments of Internal Medicine and to classify the patients according to the Edmonton Obesity Staging System (EOSS). Material and methods An observational, descriptive cross-sectional study included outpatients older than 18 years, with a body mass index (BMI) > 30, from 38 hospitals between the 1st and 14th of February, 2016. We classified the patients according to the EOSS and analyzed their clinical, laboratory and demographic variables. A value of p Results Of the 1262 patients treated in consultations, we recruited 298 and analyzed 265. The prevalence of obesity was 23.6%, the mean age was 62.47 ± 15.27 years, and the mean BMI was 36.1 ± 5.3 kg/m 2 . According to EOSS stage (0, 1, 2, 3 and 4), the prevalence was 4.9, 14.7, 62.3, 15.5 and 2.64%, respectively. Those patients with EOSS > 2 were significantly older and had significantly more comorbidities. The multivariate analysis related age (OR 1.06; p p p p 2. An analysis of correspondence grouped, with an explanatory percentage of 78.2%, the patients according to their EOSS, comorbidity, education level, employment status and functional capacity. Conclusions The prevalence of obesity in the patients treated by Internal Medicine departments is similar to that of the general population, although the patients are older and have a higher BMI. EOSS is useful for implementing a comprehensive approach for patients with obesity, regardless of the BMI, which can help achieve better health and quality-of-life results.

SARS-CoV-2 infection is associated with a high risk of malnutrition, mainly due to increased nutritional requirements and the presence of a severe and universal inflammatory state. Associated symptoms contribute to hyporexia, which perpetuates the negative nutritional balance. Furthermore, dysphagia, especially post-intubation, worsens and makes intake unsafe. This risk is greater in elderly and multimorbid patients. Inflammation to varying degrees is the common link between COVID-19 and the onset of malnutrition, and it is more correct to refer to disease-related malnutrition (DRM). DRM worsens the poor prognosis of SARS-CoV-2 infection, especially in the most severe cases. Therefore, it is necessary to identify and treat people at risk early, avoiding overexposure and direct contact with the patient. We cannot forget the role that a healthy diet plays in both prevention and recovery after discharge.

To evaluate the use of therapy with cardiovascular benefit in patients with type 2 diabetes mellitus admitted to internal medicine departments.One day, cross-sectional study of patients with type 2 diabetes mellitus hospitalised in internal medicine departments. We recorded demographic and anthropometric variables, laboratory data and use of antihyperglycaemic drugs. The endpoint was the proportion and determinants of the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA).We included 928 patients belonging to 74 hospitals, with a mean age of 78.9 years (SD, 10.86 years), 50% of whom were men. A total of 557 (60%) patients had ischaemic heart disease, 189 (20.4%) had cerebrovascular disease, 293 (31.6%) had heart failure, 274 (29.5%) had chronic kidney disease, and 129 (13.9%) had peripheral arterial disease. Prior to their hospital admission, the patients were taking sulfonylureas (5.7%), biguanides (49.1%), alpha-glucosidase inhibitors (0.2%), pioglitazone (0%), dipeptidyl peptidase 4 inhibitors (39%), SGLT2i (5.8%), GLP1-RA (2.6%) and basal insulin analogues (24%). An age over 75 years was the main determinant for not taking SGLT2i (adjusted OR, 0.28; 95% CI 0.10-0.74; P=.039) or GLP1-RA (adjusted OR, 0.09; 95% CI 0.02-0.46; P=.006).A large proportion of elderly patients with type 2 diabetes mellitus at very high cardiovascular risk are not treated with antihyperglycemic drugs with proven cardiovascular benefit. The most commonly used drugs were metformin and DPP4i. There is room for improvement in the treatment of this very high-risk population.

Objective: To evaluate the use of therapy with cardiovascular benefit in patients with type 2 diabetes mellitus admitted to internal medicine departments. Methods: One day, cross-sectional study of patients with type 2 diabetes mellitus hospitalised in internal medicine departments. We recorded demographic and anthropometric variables, laboratory data and use of antihyperglycaemic drugs. The endpoint was the proportion and determinants of the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA). Results: We included 928 patients belonging to 74 hospitals, with a mean age of 78.9 years (SD, 10.86 years), 50% of whom were men. A total of 557 (60%) patients had ischaemic heart disease, 189 (20.4%) had cerebrovascular disease, 293 (31.6%) had heart failure, 274 (29.5%) had chronic kidney disease, and 129 (13.9%) had peripheral arterial disease. Prior to their hospital admission, the patients were taking sulfonylureas (5.7%), biguanides (49.1%), alpha-glucosidase inhibitors (0.2%), pioglitazone (0%), dipeptidyl peptidase 4 inhibitors (39%), SGLT2i (5.8%), GLP1-RA (2.6%) and basal insulin analogues (24%). An age over 75 years was the main determinant for not taking SGLT2i (adjusted OR, 0.28; 95% CI 0.10-0.74; P = .039) or GLP1-RA (adjusted OR, 0.09; 95% CI 0.020.46; P = .006). Discussion: A large proportion of elderly patients with type 2 diabetes mellitus at very highcardiovascular risk are not treated with antihyperglycemic drugs with proven cardiovascular benefit. The most commonly used drugs were metformin and DPP4i. There is room forimprovement in the treatment of this very high-risk population. (C) 2020 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.

The heterogeneity of patients with heart failure and preserved ejection fraction (HFpEF) is high, thusthis entity tends to be grouped into phenotypes to act with precision. Within these groups, patients with type 2 diabetes mellitus (T2DM) hold this heterogeneity. Our aim is to describe subgroups of patients with HFpEF and T2DM based on other comorbidities.Patients were recruited from the national registry of heart failure (RCIA). Patients with ejection fraction greater than or equal to 50% without valvular disease and with T2DM were included. A hierarchical agglomerative analysis was performed with Ward's method including the following variables: dyslipidemia, liver disease, Chronic obstructive pulmonary disease (COPD), dementia, cerebrovascular disease, arrhythmia, systolic blood pressure, body mass index (BMI), estimation of glomerular filtration and hemoglobin.1934 patients with ICFEP were included, of which 907 (46.9%) had T2DM with a predominance of women (60.9%) and with a BMI of 31.1 (5.9) Kg / m2. Four groups were obtained, two with high vascular risk (one with arrhythmia and the other without it) with 263 patients the first and 201 the second. A third group had a predominance of COPD (140 patients) and a last group with 303 patients older but with less comorbidity.In our patients with ICFEP and T2DM, obesity and female sex predominated. All four groups offered treatment chances to improve their prognosis not only based on the use of new antidiabetic drugs but also on other options that may be a starting point for further research.

To estimate the prevalence of obesity in patients treated by departments of Internal Medicine and to classify the patients according to the Edmonton Obesity Staging System (EOSS).An observational, descriptive cross-sectional study included outpatients older than 18 years, with a body mass index (BMI)30, from 38 hospitals between the 1st and 14th of February, 2016. We classified the patients according to the EOSS and analysed their clinical, laboratory and demographic variables. A value of P.05 was considered statistically significant.Of the 1,262 patients treated in consultations, we recruited 298 and analysed 265. The prevalence of obesity was 23.6%, the mean age was 62.47±15.27 years, and the mean BMI was 36.1±5.3kg/mThe prevalence of obesity in the patients treated by Internal Medicine departments is similar to that of the general population, although the patients are older and have a higher BMI. EOSS is useful for implementing a comprehensive approach for patients with obesity, regardless of the BMI, which can help achieve better health and quality-of-life results.

Brucellosis, a zoonosis with a worldwide distribution, is a systemic infection that can present with involvement of both nervous and musculoskeletal systems. We report a case of spondylitis and meningoencephalitis and describe the clinical features, and difficulties in treatment. Osteoarticular complications of brucellosis are common but involvement of the nervous system is rare and it should be included in the differential diagnosis of any obscure neurologic disorder.

To study the characteristics of the venous thromboembolic disease (VTD) in a rural area of Southern Extremadura (Spain).Prospective observational study of all patients diagnosed by objective methods of VTD in the only hospital in our area from November 2002 to November 2004.Seventy-six patients were diagnosed of VTD: 35 (46.1%) with pulmonary thromboembolism and 41 (53.9%) with isolated deep vein thrombosis (DVT). The median age was 72.4 years (range 35-94 years), 51 (67.1%) were older than 70 years, and 43 (56.6%) were women. The annual incidence of VTD was 0.63 per 1,000 persons (0.74 per 1,000 persons in women and 0.54 per 1,000 persons in men). Thirty-seven patients (48.7%) had "idiopathic" VTD. After a median follow-up of 5.5 months with anticoagulant therapy, 13 patients (17.1%) had dead. Comorbidity and non "idiopathic" VTD were significantly more frequent in the dead patients. Three patients (3.9%) presented probable recurrence, and all of them died. There were 4 cases (5.3%) of non-fatal severe hemorrhage. Nine patients with isolated DVT did not require hospitalization, and there was no event in the follow-up.The incidence of VTD may be lower in our area than in other geographical areas. VTD affects more frequently to elderly and women, and almost half of cases are "idiopathic". The mortality is high, and it is related to the existence of comorbidity and non "idiopathic" VTD. The recurrences and the severe hemorrhages are not exceptional during the anticoagulant therapy. The ambulatory treatment of isolated DVT may be an option in selected patients.

To know in our area the security of no long-term anticoagulation in patients with suspected pulmonary thromboembolism (PTE) and a low probability ventilation/perfusion (V/Q) lung scan.Retrospective review of a series of consecutive outpatients with suspected PTE and a low probability V/Q lung scan, according to the modified PIOPED criteria, who receive no long-term anticoagulation.Among 38 patients with a low probability V/Q lung scan, 31 (81.6%) did not receive long-term anticoagulation. The median age was 69.1 years (range 26-88 years), and 19 (61.3%) were female. The clinical probability of PTE was moderate in 27 patients (87.1%). Twenty-two patients (71%) had a venous lower extremities echography-doppler negative for deep vein thrombosis (DVT). The median follow-up was 6.3 months (range 3-12 months). There was one case (3.2%; 95% confidence interval, 0.1-16.7%) with demonstrated PTE and DVT, and there was no death.No long-term anticoagulation in outpatients with a moderate clinical probability of PTE, a low probability V/Q lung scan and a venous lower extremities echography-doppler negative for DVT may be secure in our area.

Objetivo: Conocer en nuestro medio la seguridad de no anticoagular a largo plazo a pacientes con sospecha de tromboembolismo pulmonar (TEP) y una gammagrafía pulmonar de ventilación/perfusión (V/Q) de baja probabilidad. Material y métodos: Revisión retrospectiva de una serie de pacientes ambulatorios consecutivos con sospecha de TEP y una gammagrafía pulmonar V/Q de baja probabilidad, según los criterios PIOPED modificados, que no son anticoagulados a largo plazo. Resultados: De 38 pacientes con una gammagrafía pulmonar V/Q de baja probabilidad, 31 (81,6%) no recibieron anticoagulación a largo plazo. La edad media fue 69,1 años (rango 26-88 años), y 19 (61,3%) fueron mujeres. La probabilidad clínica de TEP fue moderada en 27 pacientes (87,1%). Veintidós pacientes (71%) tuvieron una ecografía-doppler venosa de miembros inferiores negativa para trombosis venosa profunda (TVP). El seguimiento medio fue de 6,3 meses (rango 3-12 meses). Hubo un caso (3,2%; intervalo de confianza del 95%, 0,1-16,7%) con TEP y TVP demostrados, y no hubo ningún fallecimiento. Conclusión: No anticoagular a largo plazo a pacientes ambulatorios con una probabilidad clínica moderada de TEP, una gammagrafía pulmonar V/Q de baja probabilidad y una ecografía-doppler venosa de miembros inferiores negativa para TVP puede ser seguro en nuestro medio.

Objetivo: Estudiar las características de la enfermedad tromboembólica venosa (ETV) en un área rural del sur de Extremadura (España). Material y métodos: Estudio observacional prospectivo de todos los pacientes diagnosticados mediante métodos objetivos de ETV en el único hospital de nuestro área entre noviembre de 2002 y noviembre de 2004. Resultados: Se diagnosticaron 76 casos de ETV: 35 (46,1%) con tromboembolismo pulmonar (TEP) y 41 (53,9%) con trombosis venosa profunda (TVP) aislada. La edad media fue 72,4 años (rango 35-94 años), 51 (67,1%) tuvieron más de 70 años, y 43 (56,6%) fueron mujeres. La incidencia anual de ETV fue de 0,63 por 1.000 habitantes (0,74 por 1.000 habitantes en mujeres y 0,54 por 1.000 habitantes en hombres). Treinta y siete pacientes (48,7%) presentaron ETV "idiopática". Tras un seguimiento medio de 5,5 meses con tratamiento anticoagulante, 13 pacientes (17,1%) habían fallecido. La existencia de comorbilidad y ETV no "idiopática" fueron significativamente más frecuentes en los pacientes fallecidos. Tres pacientes (3,9%) tuvieron una probable recidiva, y todos fallecieron. Hubo 4 casos (5,3%) de hemorragia grave no fatal. Nueve pacientes con TVP aislada no precisaron ingreso hospitalario, y no hubo ningún evento en el seguimiento. Conclusiones: La incidencia de ETV puede ser menor en nuestro área que en otras zonas geográficas. La ETV afecta más frecuentemente a ancianos y a mujeres, y casi la mitad de los casos son "idiopáticos". La mortalidad es elevada, y se relaciona con la existencia de comorbilidad y ETV no "idiopática". Las recidivas y las hemorragias graves no son excepcionales durante el tratamiento anticoagulante. El tratamiento ambulatorio de la TVP aislada puede ser una opción en pacientes seleccionados.